[ prevalence of defensive medicine behaviors among surgeons, its causes and potential reduction solutions: a cross-sectional study in Iran]

Introduction: defensive Medicine [DM] is defined as the deviation of a doctor from his or her usual behavior, and its aim to reduce or prevent complaints from patients or their families. This study aimed to investigate DM behaviors of the surgeons participating in the 41st Congress of Iranian Association of Surgeons [TAS] in 2017

Methods: in this cross-sectional study, 160 surgeons were selected using convenience sampling. The data gathering tool was a researcher-made questionnaire consisting of 60 items including 4 parts [demographic characteristics, the prevalence of DM behaviors, its causes and potential reduction solutions] that its validity and reliability were confirmed. For data analysis, descriptive statistics including frequency, percentage, mean and standard deviation in SPSS 21 software were used

Results: the prevalence of positive and negative DM behaviors was 100 and 80%, respectively. The most common positive DM behaviors included ordering unnecessary biopsy, imaging, and laboratory tests, and avoiding caring for high-risk patients and refusal to admit patients with a specific social status were the most common negative DM behaviors among surgeons. Lack of support of physicians by health system rules and regulations in adverse situations and fear of patient's claim were the most important reason for DM behaviors. The most effective potential solutions to the DM reduction were team decision-making in case of complex patients, modification of the law's view on medical malpractice as a crime, and more support of the legislature

Conclusion: all surveyed surgeons showed at least one of the varieties of DM behaviors, ultimately leading to increased health care costs and resources wasting as well as having negative impact on patient safety. Applying strategies such as modification of the medical malpractice rules and regulations, increasing supervision and monitoring of service provision, establishing appropriate adverse events reporting systems and blame-free culture, developing and implementing evidence-based medicine in practice and re- forming of medical liability insurance can be effective steps in reducing DM behaviors

[Clinical and radiological assessment of anterior cervical discectomy]

Cervical discectomy has a high success rate. This study aimed to evaluate clinical and radiological results of anterior cervical discectomy. This was a retrospective study in which its emphasis was on surgical outcomes in patients operated with anterior fusion surgery method along with artificial cage. The study was conducted on 43 patients who underwent standard Smith-Robinson technique. Postoperative follow-up period was 2 years. Clinical assessment was done through Odom criteria, Neck disability index and VAS. The mean age of patients was 50 y. The most common symptom was neck pain and sensory disorder was the most prevalent sign. The most common level involved was C5-6. The mean medical treatment period was 4.5 months. Motor defect and neck pain were the main reasons of surgery. According to Odom Criteria, 80% of patients had reasonable satisfaction after surgery. Also, on the basis of neck disability index and visual analog scale of neck and associated pain, patients had significant improvement. The rate of successful fusion was 95%. Due to the possibility of complete discectomy and complete removal of compression, anterior surgery approach is preferred over the posterior one.

[ study on association of glioma and cognitive impairments]

Given the prevalence of glioma and importance of cognitive impairments of these patients, it is important to evaluate these impairments using the cognitive tests that have previously shown they are capable of these evaluations. Therefore, this study compared cognitive impairment in patients with glioma and controls, in the Shohada Hospital in 2012. Historical cohort study was conducted on patients diagnosed with glioma and control subjects were matched in terms of age, gender and education. Cognitive assessment was done using computerized continuous performance test, Stroop and Tower of London [TOL] tests. Stroop test showed a significant difference between the patient's stroop test variables and the healthy ones [p<0.5], except for the incongruent response time score. In continuous performance test there was a difference between cases and controls [p<0.5]. Variables are assumed to equal for the total error scores of the first 50 stimulants and the total true score of the first 50 stimulants variables. TOL test confirmed the difference between patients and healthy people [p<0.5]. It seems that the tests are capable of assessing cognitive impairments in glioma patients.

Memory performance among children with ADHD

The present post-eventual research study was conducted with the purpose of comparing the memory performance between distinct groups of 50 healthy children and 50 attention deficit hyperactivity disorder [ADHD] children [25 girls and 25 boys] in Tehran with an age range of 10-12. The whole students were selected through simple random sampling method and were assessed in children's medical center, the Clinic of Roozbeh Hospital, and Tehran's Andishe primary school [both girls' and boys' branches]. The applied tools for data gathering were the Benton test and Wechsler memory sub-test [form A]. The results showed a significant difference between Benton test scores and Wechsler memory sub-test scores [i.e. personal and general information, orientation, mind control, logical memory, repeating numbers straightly or reversely, learning and memory] among healthy children and those with ADHD. Memory performance in children with ADHD was weaker than healthy children. In general, with regard to the memory deficit and attention disorder, these patients require both memory and attention rehabilitation for a better quality of life

[Application of cognitive computerized test in assessment of neuro-cognitive domain]

Background and Aim: The Stroop Color-Word test is a common and quick tool for assessing selective attention. This study was run to evaluate application of Stroop cognitive test in assessment of selective attention

Materials and Methods: A cross-sectional study was implemented during 6 months from June to November, 2010 on 84 healthy adults [42 males and 42 females]. All participants performed computerized Stroop test after signing consent. The cases were examined before the test to confirmtheir health status and were trained for the test

Results: The obtained data indicate that there is a significant correlation coefficient between age, gender and education variables [p<0.05]

Conclusion: The above-mentioned test can be used to assess selective attention

Demographic variables and selective, sustained attention and planning through cognitive tasks among healthy adults

Introduction: Cognitive tasks are considered to be applicable and appropriate in assessing cognitive domains. The purpose of our study is to determine the relationship existence between variables of age, sex and education with selective, sustained attention and planning abilities by means of computerized cognitive tasks among healthy adults. Methods: A cross-sectional study was implemented during 6 months from June to November, 2010 on 84 healthy adults [42 male and 42 female]. The whol participants performed computerized CPT, STROOP and TOL tests after being content and trained. Results: The obtained data indicate that there is a significant correlation coefficient between age, sex and education variables [p<0.05]. Discussion: The above-mentioned tests can be used to assess selective, sustained attention and planning

Brain metastases in patients with diagnosis versus undiagnosed primary tumor

To propose a diagnostic work-up specifically tailored to the undiagnosed primary [UDP] tumor patients. To investigate the distribution of primary tumors and presenting symptoms in UDP versus diagnosed primary [DP] patients, 50 consecutive patients with diagnosis of brain metastasis in Shohada Hospital, Tehran, Iran from January 2001 to December 2005 were included in this study. Univariate analyses were performed to assess the difference of various variables between DP and UDP patients. The UDP patients represented 46% of all. Aphasia was significantly more common in the UDP group [p=0.0008] and ataxia in the DP group [p=0.04]. The source of the metastases proved to be different between the 2 groups of interest [p=0.0006]. The lung was the most frequent primary site in both groups. Among all UDP patients, a primary tumor in a location other than the lung was only found in 17% of patients. This study validated the hypothesis that the distribution of primary tumors differs between DP and UDP patients. If lung investigation fails to disclose the location of primary tumor, the patient is unlikely to benefit from extensive paraclinical investigation. In such a situation, a neurosurgical procedure should be considered the most appropriate second step to be taken

role of medical ethics in comprehensive healthcare system

Daily development of the human knowledge, promotion of biomedical technologies and improvement of physicians' ability in diagnosis and treatment of different types of diseases have always accompanied plenty of discussions and challengeable subjects, especially from the view point of ethical issues. Obtaining deep and accurate recognition of these subjects, the attention of the physicians and the scholars of different fields, especially of the ethics has been drawn to medical ethics as a new solution in the comprehensive Healthcare System. Despite the great changes in medical technologies, there are still some concerns about the physicians' abilities in decision makings that may directly or indirectly affect the health or life of the people. Therefore these concerns have lead to the appearance of new movements all calling for the patients' rights and the rights of society to participate in medical decision-makings. On the other hand we should notice about some other cases that play effective roles in policy makings of the comprehensive healthcare system. For instance, the required resources will vary following the changes in technology; the population especially of the elderly is increasing; moreover the time needed for the new work forces to be entered into the labor market has typically increased. Consequently, a higher number of people are waiting to benefit from the recourses and lower number of them is involved in producing the recourses. Thus, to work on the important topics like the requirements of human societies, ethical considerations of biotechnology and medical researches, Allocation of limited and immense resources, important ethical criteria of decision makings, representation of fundamental solutions and medical ethics trainings is considered as one of the most basic necessities of comprehensive healthcare system among others

Bioethics teaching

The history of bioethics is traced back to Hippocrates. Bioethics has had rise and fall in its history. In its first days, philosophers and theologians were discussing and suggesting theories for practical ethics. However, the growth of technology and its effect on medicine and medical ethics considerations, has renderd deep changes in this field. The study of aims and methods in the medical ethics teaching, reveals that following of the Persians post masters doctrin, besides the usage of the last scientific results, might help us in dealing with the challenges in the medical ethics teaching